Scheduled for a Vermilionectomy for premalignant lip tissue

Welcome, @mizlynnie. From what I have read, vermilionectomy is effective for treatment of actinic cheilitis (AC) and squamous cell carcinoma (SCC) of the lower lip. Wounds produced by cryosurgery and laser therapy heal within a period of 7–14 days, while it takes two to four months for those caused by vermilionectomy. After the healing process, many patients experience good cosmetic results." Read more here: https://www.news-medical.net/health/Actinic-Cheilitis-Prognosis-and-Mouth-Cancer.aspx

I added your question to the Head & Neck Cancer group as well in the hopes that other members may have personal experiences to share. Lynn, do you know is the premalignant tissue is a pre-cursor to squamous cell carcinoma? I'm glad this was found in the pre-cancerous stage.

I meant to tag @rebeccac @donnaohm who have experience with lip cancer and may have experiences to share about vermilionectomy, a procedure where all or part of the visible lower 'red' lip will be removed.

Hello Colleen -
Thank you for your response.
You ask, is the premalignant tissue a precursor to squamous cell carcinoma?
Yes. The dermatologist said the actinic keratosis was "very advanced" and could spread to the mouth in the form of squamous cell carcinoma, hence his recommendation for me to have a vermillionectomy.

Hi, I’m new to the group & need some support. I’ve just finished Fluorobalm 1% treatment for 2 weeks on my lower lip for Actinic Cheilitis. My dermatologist said she would do a biopsy if my lower lip is not smooth when I return on March 8, 2023. I have a feeling that it will not be smooth. I also had a 2nd opinion & both dermatologists do not see or feel Squamous Cell & agree with the approach.
How long does it take for a biopsy to heal? I see that in severe cases a vermillionectomy is required which can take up to 4 months to heal. I’m scared of the thought of having my entire lower lip shaved & reconstructed.
Thanks for any positive experiences with cancer of the lower lip.

@marshaj, welcome. I can imagine how scared you are about have a vermilionectomy and the healing period. Having anything done on one's face is nerve-wracking to say the least.

I'm hoping that @mizlynnie sees your post and is able to return to share her experiences. If I recall correctly she had the procedure only recently or will soon be having it. It can really help to hear from someone who has been there.

I have seen some images of post surgery and post recovery which look very good. It appears that you with the second opinion you have confidence in the choice of treatment, which good. Your main concern is the recovery period, right?

Hi Marsha and thank you Colleen for connecting us ...
A little background: 2022 starting in early July, I had a non-healing lesion on my lower lip. My dentist insisted I have it checked out. October 2022, the biopsy results came back from the oral surgeon as Advanced Actinic Keratosis. Both the dentist and oral surgeon were surprised it was not SCC.
As the biopsy site failed to heal, I saw my dermatologist (had to wait until December 2022 for an appointment). He stated I had "very advanced" Actinic Keratosis and recommended a Vermilionectomy. He stated it was a "brutal" procedure, but in my case was necessary to preclude SCC invading the oral cavity. The first available appointment was January 17, 2023.
I was in the treatment room ready for the procedure when it was discovered that the doc's office had failed to send a script over to the pharmacy for meds needed to be taken 2 days before the procedure. The doc canceled the procedure. We rescheduled for first available slot: February 23, 2023.
Maybe a blessing in disguise ... I have since discovered a painless lesion / lump under the tongue about the size of a grape. I have an ENT appt. for the end of the month.
My lip biopsy site -- done Oct 6, 2022 -- has not healed and is ulcerated. My lip is a mess. So, I have not had the vermilionectomy yet. The doc did tell me to expect a long healing period, but the laser procedure should take care of the problem. I do empathize with your fear and concern. The vermilionectomy is not something I'm looking forward to, but the alternative is even more frightening. I'll update you when I know more or complete the procedure.
Remember everyone is different. You may not need a biopsy or even the Vermilionectomy. Keep the faith, and please keep us updated on your results.
Sending blessings your way.

I’m sorry that you’re having to go through all of this & that your procedure was halted. Maybe it truly was a blessing in disguise. I am like you, in that I know this problem has to be dealt with and with the best treatment.
I hope you can get the lesion on your tongue evaluated.
My lip has diffuse areas of sun damage. I was a lifeguard for many years & we have lived in Florida for 31 years. I have fair skin.
My nephew is a plastic surgeon in NC & told me that Actinic Cheilitis, which is Actinic Keratosis on the lip is challenging to treat. They start with a chemotherapeutic (Fluorocil lip balm in my case), then if that doesn’t work, go to other options. Being a surgeon, he said the “complete shave” of the lower lip has high success rates. He also said that the lips respond well & cosmetic results are good.
I know I’m getting ahead, but he said a biopsy is important to know what I’m dealing with. The main area is right in the middle of my lip where it looks like I bit my lip, but some of my other lip is still inflamed after the chemotherapeutic treatment.
The dermatologist told me to go on a trip that I’ve had planned for quite some time, so I’m going to try to enjoy it & worry about the biopsy when I return.
My lower lip feels dry & chapped all the time & I use Aquaphor & Vaseline to soothe.
I think I have 3 of the 6 usual signs/symptoms for lip cancer:
1. A sore that doesn’t heal
2. Pain in the lip
3. Red patches on the lip
I’m glad there is an oral cancer support group. Being around other people who are going through the same thing can be beneficial to our mental, emotional & spiritual health.

Aaha! We pretty much received the same recommendations. That's reassuring.
Forgot to mention, my doc said the procedure is done under local anesthesia, and he requires Valtrex plus an antibiotic to be taken two days before the laser treatment. He also said bathe the lip in vinegar a few times day after the procedure.
The biospy is relatively quick and simple. It's the waiting for the results that's tough.
Like you, I'm focusing on the positive right now with fingers crossed. 🙂
Enjoy your trip Marsha.
We'll be in touch.
Lynne

Again, thanks for the information. It’s interesting. Having it done under local anesthesia is better. What type of doctor is doing it?I’m wondering how patients take pills after. Place on the tongue & use a squirt bottle or put cup just to the upper lip? I have a few pills I need to take daily.
I think you will have good results with following the post-op process. You will get through it and prevent cancer. Sending positive energy your way. 😊
Thanks for the good wishes for my trip.
Marsha

Hi Marsha -
To answer your question: the doc is a dermatologist, and good question about the post-procedure meds. I bought Boost, bone broths, fruit juices, etc. to sip through a straw. Might have to crush the pills and mix with liquid. Oh, and face masks. Might need a few of them. Don't want to scare the neighbors! :-))
Cheers,
Lynne